=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417823170
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ZACH SCHROEDER BSN RN
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/10/2025
-----------------------------------------------------
Last Update Date | 10/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11958 SW GARDEN PL
-----------------------------------------------------
City | TIGARD
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97223-8248
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 844-966-6777
-----------------------------------------------------
Fax | 866-859-8195
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6610 SE 66TH AVE
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97206-7446
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 844-966-6777
-----------------------------------------------------
Fax | 866-859-8195
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WP2201X
-----------------------------------------------------
Taxonomy Name | Ambulatory Care Registered Nurse
-----------------------------------------------------
License Number | 201500294RN
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------